The internet is the most popular information source for many consumers to obtain health information [[1], [2], [3]]. However, the quality of online health information (OHI) varies greatly, and the overall quality is low [4,5]. Low-quality information can undermine people’s ability to make informed decisions and lead to harmful consequences [6,7]. Therefore, the ability to evaluate the quality of OHI is considered a major component of eHealth literacy and is critical for consumers to make effective use of the internet as a source for health information [8].
Nevertheless, assessing information quality has been a significant challenge for online health consumers [9]. The challenge exacerbates when the complexity and heterogeneity of the internet information environment increases [10], particularly with the emergence of social media where anyone can publish health information and where low-quality and misinformation spreads quickly and widely [5,11]. Interventions are much needed to tackle this public health challenge.
Two systematic reviews [12,13] reviewed interventions that intend to enhance consumer eHealth literacy, of which evaluating OHI quality is a component. Some (but not all) studies included in these reviews contained an OHI quality evaluation component. However, specifics of the design and evaluation concerning the component were not the focus of the reviews. Therefore, they provided only a fragmented view of current efforts to enhance consumer OHI quality evaluation ability, gaps in the current efforts, and opportunities for improvement.
A more recent comprehensive review [14] focused on reviewing interventions that assist health consumers in autonomously finding reliable OHI related to chronic health conditions. Seven published studies and two gray literature reports were included in the review. Due to its limit to interventions targeting consumers who concerned about chronic conditions, they missed efforts targeting other user groups and online health consumers in general. Like the two systematic reviews, this review did not separate the OHI quality evaluation module from other modules (e.g., training on basic knowledge of stroke) in the interventions. Moreover, the review identified three types of interventions: interactive workshops, health literacy curriculum and community outreach, and online portals with support via videoconferencing; however, it did not include automatic methods (e.g., credibility-based ranking algorithms) that can enhance consumer ability to access more credible OHI. Such methods represent an important and also necessary approach to address the OHI quality evaluation challenge in the age of information overload.
This scoping review intends to address these significant gaps with two goals: (1) achieve a more comprehensive understanding of the current status of research on improving or augmenting consumers' ability to evaluate OHI credibility, and (2) generate ideas for future interventions. We focused on the following research questions: What intervention approaches have been designed to improve or augment consumer ability to evaluate OHI credibility? How were the interventions designed? How were they evaluated?
Based on the Merriam-Webster dictionary, we defined interventions broadly as acts designed to interfere with the course or the outcome of consumers’ evaluation of OHI credibility. We intended to be inclusive; thus, we did not limit ourselves to specific action mechanisms. The acts could be those targeting to actively build consumers’ OHI evaluation skills or those working by shaping, focusing, or nudging user attention in particular ways to augment their ability to evaluate OHI credibility. We defined credibility as consumers’ perception of the quality of OHI and the extent to which they are willing to trust the information [15,16]. This definition implies that, in this review, we view quality as objective features of OHI (e.g., accuracy and completeness), whereas credibility as subjective or perceived features of OHI (e.g., trustworthiness and usefulness). As most online health searchers do not equip with medical expertise to objectively assess OHI quality, it is appropriate to describe consumers’ evaluation of OHI quality as a subjective process (termed credibility evaluation) that is achieved by picking up and applying source, content, or design cues [15]. We broadly defined online health consumers as those who actively or passively access health and wellness information on the internet, irrespective of the mode of access (e.g., search, browse) and the motivation to access.